Frequently Asked Questions: Private Insurance

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No. You, your spouse and your dependent children do not have to be covered under the same policy or plan. However, you, your spouse and each dependent child for whom you may claim a personal exemption on your federal income tax return must have minimum essential coverage or qualify for an exemption, or you will owe a shared responsibility payment when you file a return. For more information click here.

No. Grandfathered plans, as defined by the Affordable Care Act (ACA), are plans with an effective date prior to March 23, 2010, before the ACA became law. Grandfathered plans can continue as long as the insurance company does not make any significant changes to the plan or its benefits.

To find out more information about the Affordable Care Act (health care reform), Health First Colorado (Colorado’s Medicaid Program) expansion and Connect for Health Colorado visit the ACA Resources for Health Care Providers page. This page has been designed specifically to help health care providers and their staff answer patient questions about health care reform.

To find out more information about the Affordable Care Act (health care reform), Health First Colorado (Colorado’s Medicaid Program) expansion and Connect for Health Colorado visit the ACA Resources for Health Care Providers page. This page has been designed specifically to help health care providers and their staff answer patient questions about health care reform. You can also visit Connect for Health Colorado for more information about buying insurance through the marketplace.

To find out more information about the Affordable Care Act (health care reform), Health First Colorado (Colorado’s Medicaid Program) expansion and Connect for Health Colorado visit the ACA Resources for Health Care Providers page. This page has been designed specifically to help health care providers and their staff answer patients’ questions about health care reform and share materials that can be downloaded and displayed.

You should contact your insurance carrier directly for information on your plan’s specific benefits and covered services. Your insurance carrier can also tell you when your premium payments are due. Get contact information for insurance carriers that sell plans on the Connect for Health Colorado marketplace.

If your monthly income is below about $1,250 a month, you may newly qualify for Health First Colorado (Colorado’s Medicaid Program) beginning in January 2014. To find out if you qualify for free or low cost health insurance through Health First Colorado click here.

If you make more than about $1,250 a month, then you may qualify for financial assistance to help you buy health insurance through the Connect for Heath Colorado marketplace. To find out if you qualify click here.

If your parents have health insurance that offers dependent coverage, you can join (or stay on) their health insurance policy as a dependent and remain covered until your 26th birthday. Get more information.

Also, if you are a student, you may be able to enroll in student health offered through your college or university.

Yes. Employer-sponsored coverage is generally minimum essential coverage. If an employee enrolls in employer-sponsored coverage that provides minimum value for himself and his family, the employee and all of the covered family members have minimum essential coverage. For more information click here.

Insurance companies are required to provide a notice of termination at least 90 days before the expiration of the plan, or 180 days if the company is leaving the Colorado insurance market. The notice must contain information about any ACA-compliant plans the insurance company offers, the availability of Affordable Care Act (ACA) plans through Connect for Health Colorado, and the consumer’s ability to shop for an ACA plan offered by any other insurance company. Insurance companies cannot automatically enroll, or “map,” a policyholder into a new plan from their company.

Yes. For individuals, the loss of existing coverage is considered a triggering event that makes a person eligible for a special enrollment period to select new coverage, either through Connect for Health Colorado, an insurance broker, or directly with an insurance company.

Most individual plans are already aligned with the calendar year for health insurance, meaning they will expire at the end of 2015. Consumers in these plans can select a new plan during the next open enrollment period, which begins November 1, 2015, and ends January 31, 2016.

Individuals who have policies that will expire in the middle of the year can enroll in an Affordable Care Act (ACA) plan once they receive their notice of termination from their carrier. They will want to make sure the new plan will be effective the day following the termination date of their current plan to avoid a gap in coverage.

Individuals cannot simply drop their plan because they know it will terminate at some point this year. Voluntarily dropping coverage is not a triggering event that will allow someone to enroll outside of open enrollment. Individuals who voluntarily drop their current plan will have to wait until the next open enrollment to enroll in coverage. That coverage would begin January 2016.

Small businesses may purchase plans anytime throughout the year, without waiting for an open enrollment period. When their existing plans terminate, they can buy new plans either through Connect for Health Colorado, an insurance broker, or directly with an insurance company. The annual open enrollment period for their employees will be based on the plan’s effective date.